Cartilage Restoration Procedures with a Top Los Angeles Orthopedic Surgeon

Cartilage Restoration Procedures

If you have knee pain, you may suffer from damaged cartilage. The cartilage around your knee is a rubbery material which covers the end of your bones. This cartilage helps to absorb shock and reduce friction in your joint. As the cartilage deteriorates or becomes damaged it can limit your movement and cause you severe pain in your knee. If you do not treat damaged cartilage you can worsen the condition and eventually required knee replacement knee cartilagetherapy.

Who qualifies for cartilage restoration procedures?

Cartilage restoration procedures are a treatment for knees that are otherwise healthy, not affected by arthritis, but are still deteriorating. The treatment is typically recommended for patients who have damage to their knee cartilage caused by a sports injury, trauma, congenital abnormality, or mono disorder, or repetitive use of the joint.

What happens during the procedure?

Before your doctor agrees to go through with cartilage restoration procedures, you will have an MRI to determine how severe the injury to your cartilage is and the location and size of the damage. Many of the knee procedures performed are done with an arthroscope, which is a popular modern surgical tool/procedure used to limit the pain and recovery time for surgery.

This is a surgical tool and process which is minimally invasive and often recommended for most knees surgeries this process requires an initial incision which is quite small in your meet. After the first incision is made a long and thin tube will be placed inside the cut, this too has a camera at the end which is connected to the videoscreen inside of the operating room. The surgeon can then get a better view inside of your knee joint through this camera and knee cartilage defectdetermine where the afflicted cartilage is located and the severity of the afflicted cartilage.

Many times you can have the affected area rectified during this procedure. If the doctor finds the affected cartilage, they can make a secondary incision through which the microscopic surgical tools are inserted and the cartilage is repaired and restored. Due to the small incisions and the minimally invasive nature of this procedure, recovery time is faster than a standard surgical procedure. In addition, the surgical process itself takes an average of two hours. It is typically performed as an outpatient procedure which means you do not have to spend the night in the hospital.

What happens after the procedure?

After the procedure it is recommended that you have somebody take you home and stay with you for the first night. Within one week you should be able to dress yourself and within 4 to 6 weeks you should be completely healed. Your Los Angeles orthopedic surgeon will talk to you about any potential complications and a rehabilitation process which you will design together. Depending on the severity of your surgical procedure, you may need to complete your physical therapy under the supervision of a licensed physical therapist. This is imperative for you to regain the motion and flexibility of your knee.

Dr. Raj is the top Beverly Hills and Los Angeles orthopedic surgeon, and is an expert in cartilage restoration procedures. Most insurance is accepted, simply call (310) 247-0466 today!

 

References:

http://orthoinfo.aaos.org/topic.cfm?topic=a00422

https://www.rush.edu/services/cartilage-restoration-center

April 27th, 2015|Knee Surgery|0 Comments

The Amazing Knee – Info from the Top Beverly Hills Orthopedic Surgeon

The Amazing Knee

The knee joint is one of the most amazing joints in the body; it is also the most abused.  The knee is subjected to a great deal of stress and weight every time you put your foot on the ground. The more you weigh and the more vigorous your activity, the more stress you place on the joint. Understanding how the knee works can help you protect it from injury.Orthopedic Surgeon Beverly Hills

The knee joint is composed of four bones:

  • the thigh bone (femur)
  • shin bone (tibia)
  • smaller shin bone (fibula)
  • knee cap (patella)

These four bones are connected by muscles, ligaments, and tendons, and together these structures allow you to move and keep your knee joint stable, aligned, and healthy.

Another integral part of the knee structure is cartilage. This gel-like, elastic tissue is a security and shock-absorber system rolled into one: it prevents the ends of the knee bones from banging and grinding against each other whenever your knee moves, and it absorbs the shock that impacts your knee every time you walk, run, jog, squat, climb stairs, or even stand.

If you are an athlete, you may be familiar with the term torn cartilage. This refers to damage to a layer of thick cartilage called the meniscus. The meniscus cushions the meeting point of the tibia and femur and absorbs the impact from movement while also helping to stabilize the knee joint. The knee joint also contains articular cartilage, a smooth tissue that covers the underside of the patella and lines the area of the femur so these bones can move effortlessly whenever you bend and straighten your knee.

Because of the stress put on this large joint, knee pain and injuries are common. The most common knee problems include:

  • ArthritisKnee Injury Pain
  • Ligament injuries
  • Cartilage injuries
  • Tendonitis
  • Fractures
  • Dislocations

Each case is unique, but treatments for these conditions range from ice and rest to physical therapy, or in some cases surgery is required.

If you are experiencing knee pain or problems, schedule a consultation with Dr. Raj. He can help you get back to doing the things you love.

Read more about the knee online at: http://www.nlm.nih.gov/medlineplus/kneeinjuriesanddisorders.html

March 24th, 2015|Knee Surgery|Comments Off on The Amazing Knee – Info from the Top Beverly Hills Orthopedic Surgeon

High Tibial Osteotomy Procedure for Knee Arthritis

High Tibial Osteotomy

If you have arthritis in your knee, your surgeon may suggest a high tibial osteotomy procedure. This surgery is done to realign the angle at the knee joint between the tibia and femur, which is called an osteotomy.

xraynorm-arthritisThe advantage of this procedure is that it preserves the natural knee joint as opposed to replacing the structure with a prosthesis (device made of metal and plastic). This surgery is used for active, young patients who develop osteoarthritis of the knee that only affects one joint compartment.

Knee Anatomy and Arthritis

Knee arthritis occurs when there is loss of cartilage of the knee. The knee joint has three bones: the femur (thigh bone), the tibia (shin bone), and the patella (kneecap). These three bones form knee compartments. The femur meets the tibia to form the joint, and the patella lies at the front of the patella. These three bones are covered with cartilage, which is a white polished material that allows for smooth gliding of the bones.

When osteoarthritis occurs, the knee joint is stiff and painful. Basically, bone rides against bone. The Beverly Hills orthopedic surgeon corrects this by realigning the angle made between the bones of the leg, so the patient can shift his or her body weight, allowing the healthy side to assume the majority of stress. Realigning the knee joint angle between the tibia and femur is called an osteotomy.

Benefits of High Tibial Osteotomy

F1.largeThe high tibial osteotomy is helpful for patients with underlying pain and loss of range of motion from arthritis that affects one compartment of the knee. Once the load is decreased on the affected side of the knee, there is a delay in the need for a total joint replacement procedure. By reducing the heavy load, the pain and stiffness is also alleviated. In order to be a candidate for a high tibial osteotomy, you must have:

  • Some ligament function around the knee
  • Minimal arthritis in other compartments of the knee
  • An adequate range of motion

If your orthopedic surgeon thinks you are a suitable candidate for this surgery, a high tibial osteotomy will reduce pain and improve overall knee function. The chance of the procedure offering pain relief five years following the procedure is around 80 percent. That percentage drops to 70 percent after 10 years and down to 50 percent after 15 years.

Before the Procedure

a08fig03Prior to undergoing a high tibial osteotomy, you will have x-rays and an MRI of the knee to assess and gage the degree of arthritis and structure damage. The x-rays show the doctor how the compartment is functioning, so he or she can predict where you are carrying the majority of your weight and how to properly realign the leg to achieve the best outcome. The MRI assesses the cartilage throughout all regions of the knee joint, as well as the knee ligaments and meniscus.

You are admitted to the hospital the day of surgery, and an anesthesiologist or anesthetist will discuss available options for anesthesia with you. You also are given prophylactic antibiotics to decreased risk of infection. When you are in the operating room, the anesthesia is given, and the surgical staff prepares your knee for the operation.

Two Methods of High Tibial Osteotomy

Closing wedge osteotomy – This procedure involves removing a piece of bone below the joint of the upper tibia. When arthritis has affected the medial knee compartment (as with varus knees), the bone wedge is taken from the outer region of the tibia. Once the bone segment is removed, the two bone ends are fixed together using a metal plate and pins.

Opening wedge osteotomy – In the wedge procedure, the orthopedic specialist cuts through the tibia on the inner side to open a wedge. This is often done by adding a segment of bone graft from the pelvic bone to hold the region open. The stabilize this, the surgeon inserts a plate and pins. This knee surgeryoperation is most often done to the upper aspect of the tibia, right below the knee joint.

During the Procedure

During the high tibial osteotomy procedure, care is taken by the Los Angeles orthopedic surgeon to protect the blood vessels and nerves that are behind and around the knee joint. A small part of the fibula bone is used to in the closing wedge osteotomy, which is performed through the same incision.

Usually, a drain is inserted to allow the surgical wound to drain, and it will remain there for 24 hours. The incisions are closed and the leg is wrapped in a dry, sterile dressing. Many times, a brace will be required for a short time following the surgery.

After the Procedure

The patient is transported to a recovery room, where he or she is closely monitored following the high tibial osteotomy. An x-ray is taken of the knee to assess for alignment.

Once stable, the patient is taken to a hospital room and a physical therapist provides passive range of motion exercises. The day after surgery, you are taught to use crutches for up to three months. Most patients are able to go home three days after the procedure. Therapy continues once you are released to home, to help you improve mobility and regain muscular strength of the knee joint.

During the first week after the procedure, your leg will be swollen and the knee will feel stiff. Most orthopedic specialists prescribe regular pain medication during this time frame. It is vital for you to perform the exercises while at home to optimize recovery and rehabilitation. It may take up to six months to full recover from a high tibial osteotomy. Therefore, the most important aspect of rehabilitation is to strengthen the knee and allow it to heal.

Success Rate of a High Tibial Osteotomy

Around 70 percent of patients who have a high tibial osteotomy are satisfied with the results, and around 75 percent are able to return to sports and/or work activities. When the procedure fails, the orthopedic surgeon may suggest a total knee replacement. However, most patients who undergo this procedure have functioning knees at five to ten years following the surgery.

Risks of a High Tibial Osteotomy

All surgeries carry some risks and complications. The high tibial osteotomy is a safe procedure, but complications include:

  • Bleeding
  • InfectionBest Los Angeles Orthopedic Surgeons
  • Blood clots of the legs
  • Knee stiffness
  • Damage to surrounding blood vessels and/or nerves
  • Failure of the cut bone to heal
  • Discomfort from metal-ware and subsequent removal
  • Unexpected fractures
November 24th, 2014|Knee Surgery|Comments Off on High Tibial Osteotomy Procedure for Knee Arthritis

Overview of Allograft Hamstring ACL

Primary ACL reconstruction is a commonly performed orthopedic surgery in the United States. There are approximately 100,000 procedures performed each year in America. It is estimated that the acute rupture incidence in the general population is around one in 3,000. This condition appears to be increasing in the female athletic participants. One form of reconstruction is the allograft hamstring ACL repair.ACL Tear2

Hamstring allograft tissue comes from a cadaver, whereas an autograft comes from the patient’s own tissue. Using an allograft is beneficial, as it avoids the risk of harvest site morbidity. There is less loss of motion and less surgical time with an allograft as compared to an autograft. However, allografts do have some disadvantages, such as availability, cost, immune response, delayed graft healing, and infection risk.

Hamstring tendons are an effective graft choice for allograft ACL reconstruction. ACL allograft constructs provide equally stable components at three year follow-up when compared to other tissue grafts. For many patients, the immune response and bacterial infection risk is diminished with the modern allograft processing technique and shorter surgical time. This is likely due to the smaller incision that is required with the allograft tissue, which reduces bacterial infection risk.

Allograft Processing

anterior-cruciate-ligament-acl-reconstruction-graft-selection-osuv6n2-3-2coljpgModern allograft processing procedures have greatly improved allograft safety. Now, with nucleic acid testing for contagious viruses, there is a reduction in processing time from 22 to 12 days.

Tissue processing provides a delicate balance between preserving the biologic function of the tissue and the removal of the potentially infectious agents. Also, processing often involves terminal sterilization and/or chemical disinfectants. This reduces the risk of cross-contamination and terminal contamination.

Autograft vs. Autograft

An autograft has certain disadvantages, such as harvest-site morbidity, dependence of donor tissue integrity, and increased surgical time. Also, patients who have this procedure experience postoperative neuroma, patellar injuries, scarring, and poor repair. Additionally, when the patient’s own hamstring is used, there is a 15 percent of knee flexor strength reduction, which can affect athletes who sprint or do squatting maneuvers.

There are many advantages of allograft tissue, such as reduced operative time and improved healing of the knee. Some research suggests that there is less rehabilitation time with an allograft, as well as a reduction of stiffness and postoperative pain. In the studies that compare autografts to allografts in primary ACL reconstruction, there is consistent equivalent clinical efficacy.

Before Surgery

Once you are at the hospital, you will be changed into a hospital gown and an intravenous (IV) line is placed in the hand or arm. This is used to deliver anesthesia medications and fluids during and after the procedure. Most patients receive general anesthesia, and the surgeon will have you sign a consent form also.

The Procedure

Once in the operating suite, you are given anesthesia and monitored with brain and heart wave electrode devices. Once you are under the effects of the anesthesia, the skin is prepped with a surgical scrub and draped. The graft is prepared by trimming and cleaning tissue so the ends can be sutured. Three small incisions are made around the knee, and sterile fluid is pumped into the joint.ACL repair

A small camera is introduced into the knee joint, and any repairs are made to the ACL stump. Once the graft is placed, it is secured with a metal button, screw, or other device. After graft placement and stability is checked, the instruments are removed and a sterile dressing is applied along with a cold pack and compression wrap.

Recovery

You will be brought to the recovery unit and monitored after the ACL hamstring allograft surgery. A physical staff will go over home care and instructions with you and the person driving you home. Once home, a physical therapist will meet with you to teach home exercises and crutch use. This procedure is done on an outpatient basis, so expect to be at the hospital from six to eight hours.

October 20th, 2014|Knee Surgery|Comments Off on Overview of Allograft Hamstring ACL

FAQs on Knee Replacement Treatment

What condition requires knee replacement?

The knee is one of the primary load-bearing joints of the body. Aside from supporting the weight of the body, the knee also absorbs the impact from movement, such as walking, running, and jumping. The knee is a hinge joint that connects the femur, tibia, fibula and the patella. Articular cartilage covers the ends of the tibia and femur, as well as the posterior of the patella. This articular cartilage allows the bony surfaces of the knee to glide along each other, allowing smooth movement of the joint. Aside from this, the knee also has two rubbery, C-shaped pads known as the medial meniscus and lateral meniscus. These provide shock absorption for the knee.knee replacement

As the body ages, the articular cartilage and menisci are worn down. This happens because of the progressive wear and tear of daily use, as well as the normal physiologic process of aging. Cartilage that was once elastic stiffens, further aggravating the damage to the knee. The articular cartilage that protects the knee can be worn down, causing pain and inflammation of the affected joint. This condition is known as osteoarthritis. Osteoarthritis is a disease that appears with aging, and is associated with risk factors like obesity.

Aside from degenerative conditions like osteoarthitis, acute trauma to the knee can damage the structures of the knee to the point where it is beyond repair. Considerations must also be made to the age of the patient, and the potential gains for their quality of life.

 

How is the knee replaced?

The replacement of a joint is known as arthroplasty. During knee replacement, the entire knee is usually removed: the ends of the tibia, fibula and femur are removed, as well as the patella. The ends of the tibia, fibula and femur are then reshaped by the surgeon to fit the replacement knee. The damaged knee is replaced by an artificial knee implant that is made of non-absorbable material such as polyethelene and metal.

total knee replacementThe implant is then placed and secured in position with screws and surgical glue. The artificial knee implants glide together, replicating the movement of the knee. After the knee implant is in place, the surgeon tests the range of motion of the knee before closing the incision and ending the operation. There have been numerous advances to the field of arthroplastic surgery. New techniques have been developed to allow as much sparing of the bone as possible, and bone-sparing techniques have made partial knee replacement possible.

The knee is immobilized for some time after the procedure to allow healing of the joint. It is recommended that patients who undergo knee replacement surgery should undergo a program of physical therapy and rehabilitation. This will strengthen the stabilizing muscles of the knee, and train the patient how to ambulate with his new prosthetic knee.

 

What are the outcomes of knee replacement?

Knee replacement is normally tolerated by most patients. Patients are normally able to ambulate soon after the procedure, and most report improvements in their quality of life after the procedure. There are still risks to surgery, however, such as persistent postoperative pain or stiffness, or infection of the surgical site.

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July 16th, 2014|Knee Surgery|Comments Off on FAQs on Knee Replacement Treatment

FAQs on ACL Reconstruction Treatment

How does ACL injury occur?

Tears of the anterior cruciate ligament (ACL) are one of the most common injuries to the knee. In the United States of America alone, it is estimated that there are over 200,000 cases of ACL injury.ACL Tear2

The anterior cruciate ligament is one of the four ligaments that stabilize the hinge joint of the knee. The ACL, in particular, runs diagonally in the middle of the knee. Its primary purpose is to prevent the tibia from sliding out in front of the femur. Due to its configuration, the ACL also provides rotational stability to the knee.

ACL injury occurs when an external stress causes damage to the knee beyond what the ACL can bear, causing the ligament to tear. It is estimated that around 70 percent of ACL injuries are from non-contact mechanisms; i.e., from landing awkwardly, or from falls, and other similar accidents. Direct damage from external trauma has also been known to cause ACL tears. Athletes in high-risk sports are at greater risk for ACL injury.

 

Why is ACL reconstruction done?

Not all cases of ACL injury are eligible for surgery. The treatment option for ACL injury is conservative, when possible. This may involve rest and rehabilitation. Surgery is considered when the tear is complete, or when the damage to the ligaments is severe.

ACL reconstruction seeks to restore patency to the damaged ligament. The development of this procedure has been of great significance to athletes: prior to advances in ACL reconstruction, tears to the ACL were considered a career-ending injury, from which there was no complete recovery.

 

What is the procedure for ACL reconstruction?ACL repair

The term ACL reconstruction is actually a misnomer. The ACL is not “rebuilt”, since a torn ACL cannot be sewn back together to restore its patency. ACL reconstruction refers to the surgical replacement of the damaged ligament with a tendon that is either harvested from the patient’s own body, or from a cadaver.

Autografts refer to surgical grafts that are taken from the patient, while allografts are harvested from cadavers. The patellar tendon is most commonly used for autografts, although they may also be harvested from other parts, such as the hamstring tendons. Allografts, on the other hand, are taken from cadavers. These are associated with a higher risk of graft rejection.

After the procedure, the knee is typically immobilized to allow recover. The knee will have to undergo a gradual and progressive program of physical therapy and rehabilitation to restore normal function of the joint. Recovery from surgery can take up to a year after the procedure, and there is a risk of persistent postoperative pain and stiffness.

ACL reconstruction provides the definitive treatment of tears and injury to the ACL. It is considered the best option for complete tears of the ACL. The gold standard of ACL repair is reconstruction using patellar autografts. However, it should be noted that there are still risks with the procedure. Graft rejection remains a possibility, especially for allograft replacements. There can also be intraoperative damage to the surrounding tissues. ACL reconstruction is generally well tolerated, however, and most patients report favorable outcomes.

 

July 12th, 2014|Knee Surgery|Comments Off on FAQs on ACL Reconstruction Treatment

FAQs on Knee Injuries Answered by a Los Angeles Knee Surgeon

What is the anatomy of the knee?

Your knee is a hinge joint that connects the femur (thigh bone), the tibia and fibula (shinbones), and the patella (kneecap). Tough connective tissue known as articular cartilage covers the ends of the tibia and femur, as well as the posterior of the patella. Articular cartilage reduces friction between the bones of the knee joint by providing the ends smooth surfaces to glide across.knee anatomy

There are also two C-shaped, rubbery pads of cartilage tissue covering the top of the tibia that are known as the medial and lateral menisci. Your menisci are shock absorbers for the impact that the knee bears. The knee also has four major ligaments, namely the Medial Collateral Ligament (MCL), Lateral Collateral Ligament (LCL), Anterior Cruciate Ligament (ACL), and the Posterior Cruciate Ligament (PCL).

 

What are injuries to the ligaments of the knee?

Injuries to the knee can occur following following sudden movement or impact to the knee. This can be caused by falling, landing awkwardly, or sudden impact from an outside force, such as during tackling. Athletes and other people in high-risk professions are at greater risk for knee ligament injuries. These injuries are known colloquially as “sprains”, and can range from stretching, to partial tears, to even complete tears of the ligament.

The knee ligament that is injured depends on the manner of the aggravating injury.

  • The MCL limits the lateral movement of the knee joint, and is most commonly injured from force that hits the outer side of the knee.
  • The LCL runs between the femur and the fibula on the outer side of the knee. Similar to the MCL, the LCL also stabilizes the knee against lateral movement. It is most commonly injured from force that hits the inner side of the knee.
  • The ACL controls the backward and forward movements of the knee, and prevents the tibia from moving in front of the femur.
  • Similar to the ACL, the PCL controls the backwards and forward movements of the knee.

 

What are injuries to the knee cartilage?

The knee is the most common site of cartilage defects. Majority of these defects are caused by traumatic injury, such as from sports activities or accidents. Due to the poor blood supply to the cartilage, healing from damage is usually insufficient. Degenerative conditions such as osteonecrosis and osteochondritis can also cause damage to the knee cartilage, leading to difficulty in ambulation and pain in the knee joint.runners knee

 

What is Runner’s Knee?

The patellofemoral pain syndrome is known by its common name of “runner’s knee”. This refers to the condition of persistent pain around the kneecap, and can be found in athletes that place repetitive stress on their knees, such as runners, skiers, jumpers, football players, among others. This condition can affect either knee, or both knees, and has been noted to be more common among women than men.

There are numerous other conditions that can affect the knee, and it is advised that you should consult a Los Angeles or Beverly Hills orthopedic doctor if you are injured. Be sure to discuss your treatment options with your physician.

July 10th, 2014|Knee Surgery|Comments Off on FAQs on Knee Injuries Answered by a Los Angeles Knee Surgeon

Understanding the ACL reconstruction procedure

The anterior cruciate ligament helps hold together the femur and the tibia bones of your leg, and ensures that they stay in place during twisting motions. When it tears, the patient often experiences instability in the knee and may have trouble walking and carrying on day to day activities. The entire procedure of ACL reconstruction can be divided into three majoACL surgeon Los Angelesr parts:

  1. Pre-surgery
  2. Surgery
  3. Recovery

Before undergoing ACL surgery

A Beverly Hills orthopedic surgeon will first assess the damage in your knee and advise you on whether or not you should undergo the surgery. In case you require the surgery and opt to undergo the procedure, you may be operated upon using the anthroscopic method. Dr. Raj at Beverly Hills Orthopedic Institute performs the procedure minimally invasively with a fiberoptic camera and a small incision for the autograft. With the help of a special camera, the surgeon is able to operate on the ligament through a very small cut, and graft a substitute in place of the existing but torn up ligament.

Prior to the procedure, the patient should work on regaining range of motion and strength of the knee. This will help make the postoperative recovery easier.

What goes on in the ACL reconstruction surgery

Once you have been anesthetized, and positioned on the operating table properly, your Los Angeles orthopedic surgeon will first take a time out and verify your name and surgery details to ensure that you get the correct treatment.

  1. Obtaining the graft, that will replace the torn ligament in your knee, is the first step. The most popular choice for this graft is your hamstring tendons. In cases where the hamstring tendons are not feasible, a tendon from your other knee can also be harvested. In specific cases this graft may also be obtained from a secondary donor. Another option is to utilize a portion of the patellar tendon for the ACL graft.
  2. Once the graft has been harvested, the Los Angeles sports medicine surgeon trims and cleans the graft, and prepares it. Sutures are placed on the ends of the tendon to enBeverly Hills Orthopedic Surgeonsure they attach properly to your bones.
  3. The surgeon then evaluates your knee through the arthoscopic camera. Two to three portals are made in your knee with the help of small incisions. The camera is inserted through one of these portals. During the evaluation, the surgeon will also repair or shave any meniscal tears found in the knee.
  4. The ACL that lies torn in your knee is first removed, so that the graft can replace it. The orthopedic surgeon in Los Angeles will use a special shaver to clean the bone and prepare it for the graft. Holes are drilled into the tibia and the femur so that the graft can be attached to the bones, and also have access to the bones marrow, from which it will draw the required nutrients to heal and sustain the tendon.
  5. The graft is then passed through the tibia, and knee joint, and attached to the drilled hole in the femur and held in place using a special screw that is bio-absorbable
  6. The camera, and operating instruments are withdrawn from the portal and the incisions are closed with the help of dressing and compression wrap

Recovery

After the operation the patient will spend some time in the recovery area, where he or she will be informed about all the proper care that they must take following the procedure. Physical training is recommended and the trainer can help speed up the recovery process considerably. Typical recovery  time frame is 6 to 9 months with the physical therapy being just as important as the procedure!

June 13th, 2014|Knee Surgery|Comments Off on Understanding the ACL reconstruction procedure

Should ACL Surgery Be Done with Autograft or Allograft?

ACL reconstructive surgery of the knee is not an uncommon procedure, but it is complicated. When it has been determined that surgery is needed, many factors contribute to which one of two possible approaches will be taken with either autograft or allograft reconstruction techniques.

Autograft is when donative bone and tissue is harvested from the patient’s own body for use in reconstruction, whereas allograft uses tissue from a cadaver. Each has advantages and disadvantages, and there are oLos Angeles Orthopedic Surgeonccasions when both are required.

According to the Centers for Orthopaedics, ACL reconstructive surgery, when followed by rehabilitation, realizes results of 90-95% as good or excellent. Finding the best Los Angeles orthopedic surgeon is step one. In many instances the final decision of what grafted tissue to harvest is up to the physician and which procedure he or she feels more experienced and successful performing.

ACL autografts are harvested from one of three possible host locations. The first, patella tendon autograft is referred to as the “gold standard” and has been most popular since the 1980’s. Tendon tissue is extracted with bone from the patella (knee cap) to create a bone-tendon-bone graft. There is an advantage to fixing bone to bone; more stability, a tougher tendon, and slightly faster healing (6-8 weeks).

Disadvantages associated with patella tendon autografts include a painful donor site and an increased possibility of anterior knee pain and tendonitis even 6-12 months after surgery. People who kneel as part of acl tendon grafttheir work are not good candidates for this type of autograft as tenderness in the knee joint may prevail to some degree.

Hamstring tendon grafts, another alternative, are growing in popularity due to new graft fixation techniques that create a bond equally as strong as the patella tendon graft but with fewer side effects. This graft affixes tendon with the bone tunnel, creating a soft tissue surface that is attached and eventually absorbs into the bone.

The interference screws actually stimulate bone growth. Surgeons like the hamstring tendon grafts for younger candidates who are still growing. The procedure takes great precision to perform and because soft tissue takes longer to heal, recovery is slower to realize.

Another type of autograft, the quadriceps tendon graft is similar to the hamstring tendon graft, but involves harvesting a strip from the quadriceps tendon with bone blocks from off the top of the patella. Procedure and recovery are similar for any autograft, but this quadriceps tendon graft is preferred for revision ACL surgeries not first time patients.

Allografts offer another option in ACL reconstruction surgery and use tissue from cadavers rather than ACL Graftharvesting from the patient directly. There are definite advantages; less risk to the patient, no pain from harvest locations, fewer incision points therefore less scars, reduced post-operative pain and therefore quicker recovery.

Allografts are not commonly used for first time ACL reconstruction and not recommended for those planning on returning to activities placing high demands on ACL.

Disadvantages to allograft ACL surgery involve risk of infection from cadaver tissue such as Hepatitis, HIV, and bacterial infections as the tissue cannot be 100% sterilized without damaging properties required for healing and growing.

Top Hip Surgeon Los AngelesOther considerations such as the cause and nature of the ACL injury, age and health condition of the patient, activity level, smoking, and previous injuries will all factor in to whether autograft or allograft is best. Rehabilitation and physical therapy following surgery are always crucial to realizing maximum results and mobility.

May 31st, 2014|Knee Surgery|Comments Off on Should ACL Surgery Be Done with Autograft or Allograft?

Should I have my ACL Reconstructed?

The ACL, or Anterior Cruciate Ligament, is responsible for supporting the knee and plays a major role in keeping the knees from giving way when you walk, run, bend or jump. There are a number of factors that need to be considered when you are considering an ACL reconstruction surgery. Age, type of injury and lifestyle play a huge role in whether you require this ACL surgeon Los Angelessurgery. Pain is also an important factor and often a deciding factor for many when this problem first presents itself. But a timely procedure can help you return to full use of your knee just like it helped Dominique Easley, one of the star contenders in this year’s NFL draft,  after he suffered from an ACL injury.

ACL injury is sometimes referred to as a five second injury, and is a growing concern among athletes and people who move around a lot. The ligament has very poor healing capabilities and does not heal on its own. ACL injury can occur at any age and while athletes suffer often from them, it is a common problem, and can be easily remedied with surgery. Pain, instability and a loss in range of motions are often associated with ACL injury.

You may need ACL surgery if:

  • The ACL ligament in your knee is completely torn
  • Your knees often buckle and cause frequent instability
  • You experience too much pain when your knee gives out

Many people elect not to go for ACL reconstruction when they think they can manage the instability on their own. The injury is not always painful and is manageable for a number of people. For those who are unable to cope with the injury, or find that they injury stops them from performing day to day tasks, ACL construction offers the following benefits:ACL tear

  • It allows you to resume an active lifestyle
  • It is especially useful for athletes and sportsmen since they can resume playing
  • Offers a high degree of protection against cartilage damage in the knee in the near future
  • A reconstructed knee is very close to a normal knee and offers a chance to live normally

While there are many advantages of undergoing ACL surgery, the procedure also has a number of disadvantages which must be taken into account.

  1. ACL Surgery is not always a complete success. It may leave you with reduced pain but also cause you to give up on a full range of motions.
  2. The risk and complications associated with most surgeries also hold true for ACL

You will have to keep in mind that while ACL surgery is very effective, not everyone has to undergo it. For someone with a normal lifestyle and manageable knee pain, the surgery is completely optional. There are many activities that are not affected by ACL and unless you feel that your injury is inhibiting your daily life, you can choose not to undergo this surgery. That being said, the surgery has a high rate of success and can help you recover the full use of your knee, and allow you to lead a more active lifestyle.

May 28th, 2014|Knee Surgery|Comments Off on Should I have my ACL Reconstructed?